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The Balanced Budget Act of 1997, as amended by the Omnibus Consolidated and Emergency Supplemental Appropriations Act (OCESAA) of 1999, called for the development and implementation of a prospective payment system (PPS) for Medicare home health services. The BBA put in place the interim payment system (IPS) until the PPS could be implemented. Effective October 1, 2000, the home health PPS replaced the IPS for all home health agencies. The PPS proposed rule was published on October 28, 1999, with a 60-day public comment period, and the final rule was published on July 3, 2000. This web site contains useful information for understanding and implementing he new prospective payment system for home health agencies.

• CMS Announces 2.3 Percent Increase In Home Health Payments Rate for calendar year 2005. CMS-1265-F will be published in the Federal Register on October 22, 2004.

(PDF 56Kb) Posted October 18,2004
• CORRECTION TO: "Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2005". View the Correction Notice CMS-1265-CN
  Posted July 30,2004
• Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2005 (Proposed Rule): CMS PROPOSES 2.5 PERCENT INCREASE IN MEDICARE HOME HEALTH PAYMENT RATES View CMS-1265P Posted July 2, 2004
• OASIS Diagnosis Reporting: Case Examples - September 30, 2003(pdf 154Kb)
• Update to the Prospective Payment System for Home Health Agencies for FY2004
• Alternative Format for FY 2002 Pre-Floor and Pre-reclassified Hospital Wage Index (Urban/MSA areas) Addendum-B in the FY 2003 Update Notice - June 28, 2002 (Adobe PDF File - 822 KB)
• Update to the Prospective Payment System for Home Health Agencies for FY 2003 (Adobe PDF File - 97KB)
• Update to the Prospective Payment System for Home Home Agencies for FY 2002 -- June 29, 2001: (Adobe PDF File - 119KB)
• Update to Prospective Payment System for Home Health Agencies for Home Health Agencies for FY 2002; Correction -- July 3, 2001: (Adobe PDF File - 119KB)
• Corrections to the HH PPS Update Notice - Update September 11, 2001
• Final Rule - Prospective Payment System Published July 3, 2000 
• Corrections to the Home Health PPS Final Rule (Updated)
• Home Health Prospective Payment System (PPS) Final Rule - Press Release -
  June 28, 2000
• Home Health PPS Announcement - Nov. 29, 1999
• Summary of Changes from Proposed Rule Published October 28, 1999 Compared to the Final Regulation (Adobe PDF File - 55KB)
• Federal Register Notice of Proposed Rulemaking for Home Health PPS -
  Oct. 28, 1999

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Prospective Payment System Coding and Billing

• Health Insurance Prospective Payment System (HIPPS)Codes
• Home Health PPS Grouper Software and Documentation (hhrg0105.exe zipped 1.1MB), effective October 1, 2003:
  Contains Version 1.05 of the home health PPS case mix grouper software, which accommodates changes in OASIS reporting requirements effective 10/1/2003. The file also includes the grouper coding logic (pseudocode), test records, and demonstration programs. Consult READM105.pdf (included) for complete details. File hhrg0105.exe should be reviewed by all software developers to ensure the accuracy of their grouper programs.

• PC PRICER - program used by CMS to calculate Home Health Resource Group (HHRG) rates and all applicable adjustments.

• User Manual for Home Health PPS PC Pricer - Detailed instructions for the use of the PC Pricer software, including field definitions, claims entry instructions and sample screens and reports. (Posted 05/28/2003)
• User Manual Displayed in Sections

• DMEPOS Codes That Can Be Billed Separately During An HH Episode of Care:
  1. Key to DMEPOS Code List
     
  2. DMEPOS Code List (Zip File - 78KB) 
• Previously Unbundled Part B Therapy Services Included in the HH PPS Episode Rate

• Home Health Consolidated Billing Master Code List (Updated file; Microsoft excel format zipped 62Kb - Last Updated: 7/12/2004): An Excel workbook file containing complete lists of all codes ever subject to consolidated billing provision of HH PPS. A master list worksheet shows the dates each code was included and excluded from consolidated billing editing on claims, with associated CMS transmittal references. The master list also associates each code with any related predecessor and successor codes. Supplemental worksheets show the list of included codes for each CMS transmittal to date.

Home Health Information Resource for Medicare

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If you have a billing or operations question, please contact your RHHI. If you have additional questions, please submit them to hhc@cms.hhs.gov or write to the Division of Community Post Acute Care (DCPC), Centers for Medicare & Medicaid Services, 7500 Security Boulevard, C5-08-27, Baltimore, Maryland 21244-1850.